Margel David, Tal Raanan, Neuman Avivit, Konichezky Myriam, Sella Avishai, Baniel Jack
Institute of Urology, Rabin Medical Center - Beilinson Campus, Petach Tikva, Israel.
J Urol. 2006 Apr;175(4):1253-7; discussion 1257. doi: 10.1016/S0022-5347(05)00699-3.
We assessed the value of preoperative levels of CEA, CA-125 or CA 19-9 in patients with clinically organ confined bladder cancer to predict pathological extravesical and/or node positive disease.
Serum levels of CEA, CA-125 and CA 19-9 were measured prospectively in all patients scheduled for cystectomy for clinically organ confined bladder cancer between September 1999 and May 2004. Biomarker expression was compared between patients with pathologically organ confined disease (pT2 or less, pN0) and patients with extravesical disease (greater than pT2, or pN1 or greater), and between patients with pathologically node negative (any pT, pN0) and node positive disease (any pT, pN1 or greater).
Of the 91 patients enrolled, 46 had (51%) pathologically organ confined tumors, 45 (49%) had extravesical disease and 17 (19%) had positive lymph nodes. Preoperative serum levels of all markers were significantly higher in cases of extravesical disease than in organ confined disease. On multivariate analysis CEA with an odds ratio of 8.6 (95% CI 1.51-48.6) and CA-125 with an OR of 29.5 (95% CI 3.6-242.6) proved independent predictors of extravesical disease. CA-125 and CA 19-9 levels were significantly higher in patients with node positive disease than in those with node negative disease. On multivariate analysis CA-125 with an OR of 22.2 (95% CI 3.8-129) and CA 19-9 with an OR of 5.2 (95% CI 1.09-24.76) proved independent predictors of node positive disease.
Increase in serum tumor markers before cystectomy in patients with clinically organ confined muscle invasive bladder cancer is a strong indicator of the presence of extravesical and node positive disease.
我们评估了临床器官局限性膀胱癌患者术前癌胚抗原（CEA）、糖类抗原125（CA - 125）或糖类抗原19 - 9（CA 19 - 9）水平对预测病理膀胱外侵犯和/或淋巴结阳性疾病的价值。
前瞻性地检测了1999年9月至2004年5月期间所有因临床器官局限性膀胱癌计划行膀胱切除术患者的血清CEA、CA - 125和CA 19 - 9水平。比较了病理器官局限性疾病（pT2及以下，pN0）患者与膀胱外疾病（大于pT2，或pN1及以上）患者之间以及病理淋巴结阴性（任何pT，pN0）患者与淋巴结阳性疾病（任何pT，pN1及以上）患者之间的生物标志物表达情况。
91例入组患者中，46例（51%）有病理器官局限性肿瘤，45例（49%）有膀胱外疾病，17例（19%）有淋巴结阳性。膀胱外疾病患者术前所有标志物的血清水平均显著高于器官局限性疾病患者。多因素分析显示，CEA比值比为8.6（95%可信区间1.51 - 48.6），CA - 125比值比为29.5（95%可信区间3.6 - 242.6），被证明是膀胱外疾病的独立预测因子。淋巴结阳性疾病患者的CA - 125和CA 19 - 9水平显著高于淋巴结阴性疾病患者。多因素分析显示，CA - 125比值比为22.2（95%可信区间3.8 - 129），CA 19 - 9比值比为5.2（95%可信区间1.09 - 24.76），被证明是淋巴结阳性疾病的独立预测因子。
临床器官局限性肌层浸润性膀胱癌患者膀胱切除术前血清肿瘤标志物升高是膀胱外侵犯和淋巴结阳性疾病存在的有力指标。
